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Sub‐Sahara Africa Waits for Help

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NEW HAVEN—Each year the desert creeps farther down into the Sahel Sahel, Arabic for “border,” is the term for the six, countries at the edge of the Sahara's southern rim: Chad, Mali, Mauritania Niger, Senegal and Upper Volta.

There I saw paved roads as red with the red desert dust as the unpaved roads. The baobab was coated red. Red covered the leaves of the mango and the flowers of the oleander, A colleague's white hair was shaded cinnabar after the Land Rover ride to.an outpost dispensary.

The spoor of epidemics appears in sub‐Sahara Africa.

Some 25 million people struggle to survive, of whom ‘about two million are nomads. Nearly eight million people, displaced by drought and famine, are now de facto refugees within their own lands or in neighboring countries.

It is six years now that the rains have failed to a greater or lesser degree. As the drought intensified and famine spread, epidemic. disease, always on the prowl, increased in ferocity. Measles, a killer in undernourished and primitive countries, has grown more lethal.

In Niger, where I found the scarce hospital beds filled with sick children, measles fatality rates have tripled, so that in 1972 more than. 2,000 people died of measles in a population of 5.5 million. In the United States it would mean instead of the 90 that died, 80,000 deaths from measles! In the unscreened hospital wards, undernourished mothers rock fly‐covered, listless, emaciated infants.

Other dread killers lurk as yet unidentified, waiting for their opportunity. At the Institut Pasteur in Dakar, Senegal, scientists showed me that viruses isolated from mosquitoes two years ago, with no known human disease associated, were recently recovered from epidemics that would otherwise have been classified as “malaria” in the bush. What other epidemics of what virulent disease lie cloaked in “malaria,” preparing to invade the crowded camps of nomads and the cities overflowing with undernourished refugees?

Yellow fever sputters around the Sahel. If it should return, in full flower, it will be well along its way around the world before the danger signals fly.

Our Government and American foundations have withdrawn from epidemic intelligence and disease control in Africa. Dr. Yves Robin showed us the few million doses of yellow fever vaccine stocked in his freezer in Dakar. But the manufacture has dwindled along with the funds. Hundreds of millions of doses will be needed, which would take years to develop even if technicians were available.

Hunger, malnutrition and disease have been the constant fate of the Sahel peoples for generations. The added weight of the drought‐induced famine has been to create larger pools of susceptibles, crowded into camps and cities in closer contact. More are infected, more die. Malaria is omnipresent. In the open markets more lepers can be seen than have been found in Europe or North America since the Middle Ages. Tuberculosis and syphilis are widespread.

International agencies and the United States Agency for International Development are accused of footdragging. They are bitter over these accusations. The weakness of the means of providing aid in these countries is overwhelming. All‐weather roads are few and railroads fewer; rolling stock is negligible; trucks and vehicles are in short supply and in poor repair. There are practically no maintenance or repair facilities, spare parts or replacement materials.

Gasoline is $1.50 to $2 a gallon. There are fourteen‐Nigerian doctors and fifty others under contract for 5.5 million in Niger. The needed food and supplies, delivered to the docks at Dakar and Abidjan, Ivory Coast, can be transported to the scattered populations or to the concentrations of sick and hungry in the distant cities only with great effort.

The surgeon of a Belgian medical team went home because there were no operating facilities. Children are inoculated with harmless water because a “cold chain” cannot be maintained between freezer, refrigerator, and operator in getting vaccine to the people.

Mobile medical teams, a French contribution, are heroically active but limited to one or two for every million people. Doctors average one for 10,000 people in the bush (compared to one for 650 here). Niger's budget for health services last year came to about 80 cents per person (it was $440 here). Niger has budgeted 15 cents per person for all medications this year.

In a local dispensary, the babies are wretched specimens: Year‐old infants look like newborns, cry weakly, barely suckle, and the milk is insufficient The need is for food, medicines, doctors, transport—in a word, everything.

Sending our doctors would not help. Health officials there know this. Provision of emergency food and medicines and basic supplies—even tables and chairs are lacking!—is urgent. Sahel government officials want and can use simple drugs, simple equipment.

At the same time, the countries In jeopardy need a powerful transformation at their very foundations to enable them to survive and build in nonemergency times. Addressing this overwhelming need. too narrowly is to vite future famines and a long slide into disaster and disease for more people—those ,as yet, untouched.

A.I.D. and international. agencies must help in this twin effort. Africa needs immediate and long‐term help simultaneously. It is unlikely that all that need's to be done can be done. We probably do not even know‐the real dimensions of the need. Perhaps the best we can do is reach a level of inadequacy our consciences will tolerate.

Africa waits.

A version of this archives appears in print on September 22, 1974, on Page 217 of the New York edition with the headline: Sub‐Sahara Africa Waits for Help. Order Reprints|Today's Paper|Subscribe